Question
Is PEP effective if taken 48 hours after exposure?
2 July 2021. Related: All topics, PEP/PEPSE.
I paid for sex with a woman but the condom tore and I only realised after I was done. There is a high chance that she was HIV positive. I started PEP after 48 hours.
I got a PCR test done 17 days after exposure. It had a less than 20/ml (undetectable) result.
Now between 14 and 35 days after exposure I have had signs of thrush, mild red rash on my face and a couple elsewhere. But no fever or swollen lymph glands.
Can the rash and thrush be because of utter stress and obsession?
My doctor says that the PCR can be relied upon and that I am negative.
Can the PEP have reduced the viral load to less than 20/ml as I took it for 15 days before the PCR test?
Please give your expert advice. I am very anxious. Thank you.
Answer
Thank you for your question.
The risk of HIV from one broken condom is very low. If your partner had an undetectable viral load on treatment, then the risk would be zero. If they were not on treatment the risk might still be only 1 in 300 or lower.
You cannot guess someones HIV status so your assumptions might also be wrong.
You started PEP within 48 hours, so it is likely it will work.
PEP – stands for Post-Exposure Prophylaxis. It is a term used for taking HIV drugs to reduce the risk of infection. PEP usually involves taking a combination of three HIV drugs for one month. The earlier PEP is started, the more likely it will work. Ideally, this should be within a couple of hours. If this is not possible, then still the earlier the better.
Some guidelines include a two-day window to do this (i.e. within 48 hours). After this, effectiveness is much less likely. Other guidelines allow up to 3 days (i.e. within 72 hours). Sometimes this may be more for psychological benefit. For example, if someone is very stressed or traumatised.
No guidelines recommend starting PEP after 72 hours.
After finishing PEP you need to wait a 4-6 weeks before testing.
If the PEP has worked, or the person was not initially infected, this will show as a negative HIV test. The test you did 17 days after the exposure will not be accurate yet.
If the PEP has not worked, this will be shown in a positive test result. Testing 4 weeks after PEP will detect 95% of infections. Testing after six weeks will detect more than 99% of infections. This result doesn’t need to be tested again.
If PEP has not worked, serosonversion usually occurs 1-3 weeks after PEP is finished. However, only 80% of people show symptoms.
Please test 6 weeks after you finished PEP is finished. If you test any earlier, you need to take a second test 3 months later.
Viral load (PRC) tests are not approved to test for HIV. In some cases they can have a role.
Please see a doctor to talk about your symptoms he best way to confirm what is causing them is to see your doctor. He/she will be able to diagnose and treat the symptoms accordingly.
Please see this link for more information about PEP:
https://i-base.info/qa/factsheets/pep-faq
Note: This answer was last updated in July 2021 from an original post from December 2011.
I have sex with a female sex worker at about 10:29pm, the condom broke after ejaculation. The next day 9:30 am I went to a clinic and explain to the doctor about what happened after some test, I prescribed Lamuvidine for 1 month. I started taking the drugs 9:30 am that same day. But I am still scared.
Hi Kenny, your PEP regimen is a first-line combination to be used. Countries differ in their cut offs for when to prescribe PEP. Later than 48 hours is sometimes questioned given the evidence base for PEP. Unfortunately given how the efficacy would be studied, it is not ethical to do so and figuring out exact efficacy at certain time points becomes impossible.
In your case this is further complicated by managing to access Truvada, earlier than when you had access to the complete regimen. Given Truvada is used within PEP it would suggest there would be benefit from taking it earlier. This perhaps increasing the efficacy of PEP in this situation. When taken following guidelines, as in your case, PEP works in ~80% of cases.
Have you considered PrEP instead of looking for a PEP regimen? While holding onto some PEP to cover the time to access a full course is beneficial, preventing the need for PEP is the best way to reduce risk. PrEP can be both daily or on-demand – PrEP can be given to best fit your life. PrEP will prevent the risk of transmission even when not using a condom. This link will explain more: https://i-base.info/guides/prep
Hi,
I’m a male and bottom. I had sex with another male that is a top. I didn’t have access to PEP. So I took generic Truvada 2 pills 30 hrs later and another pill 15 hours later. Total of 3 Truvada pills in the last 45 hours.
I was able to get in touch with a medical doctor on the third day and got prescribed an official PEP regimen (generic Truvada and Tivicay). I took 1 pill of Truvada and Tivicay together 65 hours after the sex.
I would like to know how effective is my PEP regimen based on my history and timeline. Are the 3 Truvada pills I took before my official PEP regimen effective? Also, taking PEP 65 hours after the sex, what is the efficacy?
Also, can my doctor prescribe me Tivicay and Truvada after my PEP is over and I tested negative? so I can keep the Tivicay for the future when I need it and take it with Truvada as my PEP regimen? Because getting PEP medication is time-consuming when I have to run to the pharmacy, and I have to wait for the pharmacy to open. PEP Accessibility is not fast enough, especially when we are in a time crunch. Thank you
Hi Wisani, how long did you wait to test after finishing PEP? The tests that your girlfriend are having will be very accurate. It is very encouraging that she is testing negative. Have you spoken to a doctor about the symptoms you are experiencing? As you have tested negative, it is more than likely that you are HIV negative.
I was on pep last of last year 2020(lamivudine and zidovudine)…after pep i went to test and it came back negative but now am scared to go n test again as i have been experiencing some symptoms,sore throat since 2020 even now,losing weight especial on my arms and legs,some white pimple that pop up on my eyes,bloating and high fever.the way things are am even scared to tell my girlfriend about what i came across and now she is pregnant with my child,so every month she goes to the clinic for check up and they test her for hiv and it says hiv negative(she says).i wanted to ask as to how accurate are those test kit because the symptoms that i have makes me think that im hiv positive.
Hi Jarvis, there is no risk of transmission in this event. Please follow this link for more information about testing and transmission: https://i-base.info/qa/factsheets/hiv-transmission-and-testing
Hi,
Had serial encounter with a lady,rubbed on her condomless,but didn’t insert inside,although her fluids touched my testicle and just noticed I had a small cut on my finger which must have contacted the fluids too.Was unable to convince her for HIV test,hence started PEP,
Am worried,what are chances of transmission?
Hi Victor, is there a reason you are not trusting of this man? If you didn’t know his status it is much more likely that he was negative than positive. Furthermore, as the insertive partner your risk is further reduced (if any risk at all). Please see this link for more information about testing and transmission: https://i-base.info/qa/factsheets/hiv-transmission-and-testing
PEP within 72 hours is considered effective, as you started so soon it will likely work. Most people choose to abstain from sex while on PEP – owing to the fact they are unsure of their status. However if you use a condom there will be no risk to your gf. Or in this period she could consider using PrEP: https://i-base.info/prep-for-women/ However as this is a very low risk, you might be able to speak with your gf and decide there is no need for any precautions and continue your sex life as you have been.
Hello
I had condomless sex with a male on feb 26(insertive). That was my first (and I think last) MSM. I don’t know the status of the guy, but after the encounter I didn’t trust him and I started taking PeP 6 hours after the exposure. What are the chances of effectiveness, and should I stop having sex with my gf during the treatment? I’m willing to tell her the truth, I really regret all the situation, since I didn’t enjoy it as I though and now I feel kind of scared
Hi Elton, starting PEP as early as you have will give it the best chance at working. There is good efficacy if taken within 72 hours, starting within 5 hours is only going to increase this. Transmission of HIV after 1 exposure is very rare.
If you do not know his status it is much more likely that he is negative. In terms of general population far fewer people are negative than positive. At this point you can only take his word that he is negative but there is no reason not to trust him. Also, given the type of exposure you had the risk of transmission is further reduced. This link will explain more: https://i-base.info/guides/testing/risks-for-transmission
I am sorry to hear that you are feeling anxious but it is important to remember you have done everything right. Anal sex with another male does not equate to definite HIV transmission. It is healthy sex that does not need to be associated with HIV. Please follow this link for dealing with anxiety around testing and transmission: https://i-base.info/guides/testing/hiv-testing-feelings-of-fear-anxiety-and-guilt